重庆医科大学：《内科学》课程教学课件（PPT讲稿）心肌病 Cardiomyopathies

ardiomyopatne (心肌病) Department of Internal Medicine 1st Affiliated Hospital, Chongqing University of Medical Sciences QIN Jian

1 (心 肌 病） Department of Internal Medicine 1 st Affiliated Hospital, Chongqing University of Medical Sciences QIN Jian

Introduction ◆A group of diseases; Involvement of the heart muscle itself; ◆Not the result of pericardial(心包)， hypertensive(高血压)，congenital(先天性)， valvular(瓣膜)，or ischemic(缺血性)diseases. Restricted to diseases solely involving the heart muscle with unknown causes

2 Introduction ◆A group of diseases; ◆ Involvement of the heart muscle itself; ◆ Not the result of pericardial(心包), hypertensive(高血压), congenital(先天性), valvular(瓣膜), or ischemic(缺血性) diseases. ■Restricted to diseases solely involving the heart muscle with unknown causes

Classification Idiopathic cardiomyopathies of unknown cause): ◇Dilated cardiomyopathy(DcM,扩张型心肌病) ◇Hypertrophic cardiomyopathy(HCM,肥厚型心肌病) ◇Restrictive cardiomyopathy(RCM,限制型心肌病) Arrhythmogenic right ventricular cardiomyopathy Unclassified cardiomyopathies ◆Specific cardiomyopathies:Alcoholic(酒精性)， drug-induced and endemic cardiomyopathies 方性心肌病)，etal

3 Classification ◆ Idiopathic cardiomyopathies ( of unknown cause): ◇ Dilated cardiomyopathy ( DCM, 扩张型心肌病 ) ◇ Hypertrophic cardiomyopathy (HCM,肥厚型心肌病) ◇ Restrictive cardiomyopathy (RCM,限制型心肌病) ◇ Arrhythmogenic right ventricular cardiomyopathy ◇ Unclassified cardiomyopathies ◆ Specific cardiomyopathies : Alcoholic (酒精性) , drug-induced and endemic cardiomyopathies (地 方性心肌病)，et al

Dilated cardiomyopathy (DCM) 护张型心病)

4 (DCM)

200310/301741:30 Normal long axis image Long axis image from DCM

5 Normal long axis image Long axis image from DCM

Definition(定义) A syndrome characterized by: ◇ventricular chamber dilation(心腔扩大) ◇impaired systolic function(收缩功能减 of one or both ventricles ； ◇arrhythmias(心律失常). ◆Most common in middle-aged males(中年 男性)

6 Definition（定义） ◆A syndrome characterized by: ◇ ventricular chamber dilation(心腔扩大）； ◇ impaired systolic function (收缩功能减 退) of one or both ventricles ; ◇ arrhythmias (心律失常) . ◆ Most common in middle-aged males (中年 男性)

Etiology (病因学) ◆Unclear cause. Three possible basic mechanisms of damage: familial and genetic factors; ◇viral myocarditis(病毒性心肌炎)and other cytotoxic insults; immunological abnormalities

7 Etiology （病因学） ◆ Unclear cause. ◆ Three possible basic mechanisms of damage: ◇ familial and genetic factors; ◇ viral myocarditis (病毒性心肌炎) and other cytotoxic insults; ◇ immunological abnormalities

Pathology ◆Postmortem examination(尺体解剖）： enlargement and dilation of all four chambers(四个心腔均增大、扩张)； ◇normal cardiac valves（正常心脏瓣膜)； normal coronary arteries (正常冠状动脉)； ◇intracavitary thrombi(血栓)

8 Pathology ◆Postmortem examination (尸体解剖）: ◇enlargement and dilation of all four chambers (四个心腔均增大、扩张); ◇ normal cardiac valves （正常心脏瓣膜）; ◇ normal coronary arteries （正常冠状动脉）; ◇ intracavitary thrombi （血栓）

Clinical manifestations ◆History: asymptomatic -early stage, symptomatic -later; symptoms of congestive heart failure usually left-and right-sided heart failures occur simultaneously）(心力衰 竭，左、右心衰同时发生)； ◇emboli and sudden death(血栓、死)； ◇all kinds of arrhythmias(心律失當)

9 Clinical manifestations ◆History: ◇ asymptomatic - early stage, symptomatic - later; ◇ symptoms of congestive heart failure ( usually left- and right- sided heart failures occur simultaneously )（心力衰 竭，左、右心衰同时发生） ; ◇ emboli and sudden death （血栓、猝死）; ◇ all kinds of arrhythmias (心律失常）

Clinical manifestations(临床表现) Physical examination: findings of congestive heart failure (心衰)； ◇cardiac enlargement(心y脏增大) systolic murmurs-non-organic due to mitral or tricuspid valvular regurgitation ) ◇arrhythmias(心律失常) 10

10 Clinical manifestations(临床表现) ◆ Physical examination: ◇ findings of congestive heart failure （心衰）; ◇ cardiac enlargement（心脏增大）; ◇ systolic murmurs- non- organic ( due to mitral or tricuspid valvular regurgitation ); ◇ arrhythmias（心律失常）